“Continuing with the status quo is not an option”: Proceedings from an international virtual townhall discussion on long-term care in the time of COVID-19

The COVID-19 pandemic has been particularly devastating for long-term care (LTC) residents and their communities. In response to this, researchers, clinicians, and policy experts from around the world, including CITF-supported researchers Drs. Andrew Costa, George Heckman, and John Hirdes, came together in a virtual conference to address critical issues in LTC related to COVID-19 and to develop practical policy recommendations. This article, published in The Journal of the American Medical Directors Association (JAMDA), summarizes the themes of the meeting and provides recommendations for supporting seniors in a safe and supportive manner.

Identified themes:

Physical Infrastructure: Data from Canada and the United States showed that the primary determinant of COVID-19 outbreaks in long-term care (LTC) homes was the level of COVID-19 circulating in the community. Additionally, large LTC facilities, with older building standards, crowding, shared rooms and washrooms, and chain operated LTC homes experienced more outbreaks than other facilities. An analysis from Ontario showed that ~30% of LTC deaths could have been avoided if residents had their own secure rooms.

Infection Control and Frail LTC Residents: The challenges of balancing public health priorities and the health impacts on residents of lockdowns and visitor restrictions during a pandemic was discussed. Hong Kong was used as an example of having relatively good infection control measures as in that country, LTC facilities were able to avoid SARS-CoV-2 outbreaks throughout the first two waves. However, in the third wave, 16 LTC homes in Hong Kong did have outbreaks. Following the SARS pandemic in 2003, LTC facilities in Hong Kong adopted guidelines for the prevention of communicable diseases which have been regularly updated since. Infection controls should be implemented, but in a way that present no harm to residents and respect their autonomy.

Staffing: Attendees discussed LTC staffing and how informed guidelines could better facilitate optimal staffing models, training, and care. The group discussed recommendations from the Royal Society of Canada’s Working Group on Long-Term Care. There is a recognition that more staffing is needed, as well as better workforce planning and training for all staff members: from unregulated care staff to physicians. Greater on-site physician presence was associated with better outcomes for residents. The discussion concluded with a call to implement a quality framework for LTC using relevant clinical information, to inform how best to organize, train, and certify clinical staff.

In summary, the authors echoed the messages of over 130 experts from five continents who recognized that there is a lot of work to be done to create real and meaningful change for older individuals living in LTC facilities. The physical environment in which LTC residents reside should be redesigned to promote optimal well-being for residents as well as better infection control. Infection control measures need to respond to both physical and psychosocial supports in a holistic manner. Staff working in LTC deserve stable employment, and well-supported training environments. Implementing an effective quality assurance system based on solid data can bring real and meaningful change for frail seniors worldwide.